Is total elbow arthroplasty indicated in the treatment of traumatic sequelae? 19 cases of Coonrad-Morrey^® reviewed at a mean follow-up of 5.2 years - 04/02/14

Doi : 10.1016/j.otsr.2013.10.012

P.Y. Barthel ^a,^⁎ , P. Mansat ^c, F. Sirveaux ^b, F. Dap ^a, D. Molé ^b, G. Dautel ^a
^a Service de chirurgie plastique et reconstructrice de l’appareil locomoteur, Centre chirurgical Emile-Gallé, CHU de Nancy, 54000 Nancy, France
^b Service de chirurgie orthopédique et traumatologique, Centre chirurgical Emile-Gallé, 54000 Nancy, France
^c Service de Chirurgie orthopédique et traumatologique, CHU Purpan, 31000 Toulouse, France

^⁎Corresponding author.

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Abstract

Introduction

Traumatic sequelae of the elbow are difficult to manage because of bone deformities, changes in joint congruency and bone defects.

Materials and methods

Total elbow arthroplasty is a therapeutic option when the joint space has disappeared. Nineteen patients underwent semi-constrained Coonrad-Morrey^® total elbow arthroplasty in 12 cases for post-traumatic elbow arthritis (group 1) and in seven cases for 7 non-union of the distal humerus (group 2). The mean age at surgery was 60years old (56 in group 1 and 67 in group 2). The mean delay between the initial trauma and arthroplasty was 16years (group 1) and 22months (group 2).

Results

At a mean follow-up of 5.5years (24–156months) in group 1, the Quick-DASH score was 34 points with outcomes that were considered to be good to excellent in 75% of the cases according to the Mayo Elbow Performance Score (MEPS). A progressive radiolucency was identified on X-ray in 33% of the cases, and moderate wear of the polyethylene insert in 17%. There were 7 complications (58%) requiring revision in 3 cases (25%). At a mean follow-up of 4.6years (24–108months) in group 2, the Quick-DASH score was 39 points with good and excellent results in 86% according to the MEPS. A radiolucency was noted in 28% and moderate wear of the inserts in 14%. There were 2 complications (28%) requiring revision in 1 case (14%).

Conclusion

Semi-constrained total elbow arthroplasties provide recovery of functional range of motion with a stable and pain-free elbow for post-traumatic conditions. The age at surgery is a risk factor for complications. The indication for total elbow arthroplasty in patients under 60 should be carefully considered in relation to alternative treatment options.